Wednesday, 4 October 2017

ECG of the Week - 2nd October 2017 - Interpretation

The following ECG is from a 16 yr old male who presented with episodes of feeling unwell, nauseous and dizzy. He is on no medication and was investigated for palpitations 7 yrs ago without cause identified.


Click to enlarge
Rate:
  • Initial ventricular rate ~150-160 bpm
  • Period of ventricular bradycardia
  • Subsequent increase in ventricular rate
  • Atrial rate variable ~100-110 bpm
Rhythm:
  • Initial 7 complexes
    • Mix of sinus and accelerated junctional rhythm
  • Next 2 ventricular complexes
    • 2:1 AV block
  • Period of complete AV block / high grade AV block
  • Next 2 ventricular complexes
    • SInus rhythm
  • Followed by accelerated junctional rhythm
Axis:
  • Right axis deviation
Intervals:
  • PR - Normal
    • During periods of sinus conduction
  • QRS - Normal
Additional:
  • Dominant R waves leads V1-2
  • Meets voltage criteria for biventricular hypertrophy
  • Nil features of strain or Q waves
Interpretation:
  • Tachy-brady syndrome
    • Accelerated junctional tachycardia
    • High grade AV block
    • Patient was symptomatic during these episodes of bradycardia complaining of dizziness and nausea. During episodes of tachycardia he experienced palpitations.
What happened ?

He had no reversible cause including culprit medications and normal biochemical assessment. He was transferred for tertiary managment and following further investigation including EP study underwent a PPM insertion.

References / Further Reading

Life in the Fast Lane

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.